Considerations in Forehead Reduction for Men.

Although frontal prominence is an infrequent benign defect that causes no sequelae, it gives the patient distress due to its unaesthetic visual aspect. Proper surgical recontouring of the forehead can radically change one's appearance. In consequence, different techniques have been proposed for its management and correction. The aim of this study is to describe a surgical algorithm to treat male patients with forehead reduction to soften the "forceful" look. An observational cross-sectional study was conducted at the head and neck surgery ward of a general hospital between 2019 and 2022. We performed 35 forehead reduction operations on male patients. The median age was 29 years (range, 26-32 years). The forehead reduction procedures performed was categorized as follows: 27 anterior table osteotomy and 8 anterior table osteotomy contouring. Median forehead reduction was 2.7 mm (range, 2-3.2 mm). The average medical follow-up for patients was 6 months, with an interval ranging from 4 to 8 months. Surgery of the forehead in properly selected male patients is sufficiently safe that it can be done for entirely aesthetic reasons. The choice of surgical technique depends on the presence or absence of the pneumatized frontal sinus. If the frontal sinus is not pneumatized, an anterior table contouring is performed and if the frontal sinus is pneumatized, an anterior table osteotomy is preferred.

Surgical Treatment and Reconstruction of Nasal Defects According to the Aesthetic Subunits Principles.

The aim of this study was to determine the prevalence of nasal skin cancer, its location by facial aesthetic subunits and the type of reconstructive procedures performed for each nasal subunit after excision for nasal skin tumors. Observational cross-sectional study of all consecutive patients with the diagnosis of skin tumor located in the nasal unit, treated from 2018 to 2019 by the department of head and neck surgery of a general hospital. 60 patients were treated with nasal skin tumors excisions. A total of 52 patients (86,6%) had basal cell skin cancer, 7 (11,6%) had squamous cell skin cancer and 1 (1,6%) had melanoma. Fifty-nine patients (98.33%) presented a primary tumor and just 1 case (1,66%) recived a previous surgical treatment. Regardless of the type of tumor, the tip subunit was the most often involved with 29 (48,33%) cases in total. Despite of the nasal aesthetic subunit affected, the most frequent type of procedure used for reconstruction was the rotation or advancement flap, based on aesthetic nasal subunits, which was performed in 39 cases (65%). Nasal reconstruction after skin cancer can be very complex, especially since all patients have high expectations about the results. In order to achieve good results, there is a necessity for careful analysis of the defect, correct planning and excellent technical execution of the procedures Frequently, staged procedures will be needed to achieve an optimal result.

Facial Reconstruction According to Aesthetic Units.

CONTEXT: The facial subunit principle organizes the facial skin into subunits. Facial reconstruction for skin cancer based on aesthetic units consists of replacing the entire subunit when a large part of a subunit has been removed. AIMS: To determine the prevalence of facial skin cancer, their location by facial aesthetic units, and the type of facial reconstruction used in each of them. SETTINGS AND DESIGN: An observational cross-sectional study was conducted at the Head and Neck Surgery Service of a general hospital between 2017 and 2018. MATERIALS AND METHODS: A population census was conducted during this period. STATISTICAL ANALYSIS USED: The categorical variables were expressed as frequencies (percentages). Continuous variables were described as the means and standard deviations or medians and interquartile ranges. RESULTS: The most common skin cancer was basal cell skin cancer, followed by epithelial skin cancer and, at last, melanoma. In general, the most frequent localization of these cancers was the nose. CONCLUSIONS: In spite of primary closure being the most common form of reconstruction, a considerable number of patients required facial reconstruction based on aesthetic facial units, with satisfying results.

Planificación virtual y modelo de impresión en 3D para reconstrucción mandibular con colgajo libre de peroné en ameloblastoma mandibular / Virtual planning and 3D printing model for mandibular reconstruction with free fibular flap in mandibular ameloblastoma

El ameloblastoma es un tumor benigno, localmente agresivo, que ocasiona deformidades faciales y con tendencia a la recurrencia. El objetivo del tratamiento del ameloblastoma es la remoción completa del tumor, la restauración de la función y el mantenimiento del aspecto estético. Se presenta el caso de un varón de 19 años que presenta tumoración en región mandibular y acude a consulta para tratamiento quirúrgico. Se realizó planificación virtual y modelo de impresión en 3D para reconstrucción mandibular con colgajo libre de peroné y modelo estereolitográfico para el manejo de su patología. Se observó una evolución post operatoria favorable; y una patología compatible con ameloblastoma mandibular intraóseo de patrón plexiforme. Si bien la cirugía es el tratamiento de elección para el diagnóstico de ameloblastoma; la planificación virtual y el modelo de impresión en 3D para la reconstrucción son herramientas útiles en el manejo de esta patología.

Ameloblastoma is a benign, locally aggressive tumor that causes facial deformities and a tendency to recur. The objective of the treatment of ameloblastoma is the complete elimination of the tumor, the restoration of function and the maintenance of the aesthetic appearance. The case of a 19-year-old male presenting a tumor in the mandibular region is presented and a consultation for surgical treatment is accessed. Virtual planning and 3D printing model were performed for mandibular reconstruction with fibula-free flap and stereolithographic model for the management of its pathology. A favorable post-operative evolution evolved; and a pathology compatible with intraosseous mandibular ameloblastoma of the plexiform pattern. Although surgery is the treatment of choice for the diagnosis of ameloblastoma; Virtual planning and the 3D printing model for reconstruction are useful tools in the management of this pathology.

Fracturas del tercio superior facial. Experiencia en el Servicio de Cirugía de Cabeza, Cuello y Máxilo-Facial del Hospital Nacional Dos de Mayo, 1999 û 2009 / Superior third facial fractures at Dos de Mayo National Hospital Head, Neck and Maxillo-Facial Surgery Service, 1999 - 2009

Introducción: Las fracturas del tercio superior facial corresponden a una patología importante pero poco frecuente en la especialidad de cabeza, cuello y máxilo-facial, consecuencia de traumatismos severos; determinarlas por edad, sexo y agente causal ayudará para su manejo. Objetivos: Determinar la presentación de fracturas del tercio superior facial por edad, sexo, agente causal y clasificación. Diseño: Estudio observacional descriptivo. Lugar: Servicio de Cirugía de Cabeza, Cuello y Máxilo-Facial del Hospital Nacional Dos de Mayo, Lima-Perú. Participantes: Pacientes con fractura del tercio superior facial. Métodos: Recolección de datos registrados en las historias clínicas, entre junio 1999 y mayo 2009. Principales medidas de resultados: Edad, sexo, agente causal y clasificación. Resultados: Se encontró 49 pacientes, 90 por ciento de sexo masculino, 67,5 por ciento entre 21 y 40 años de edad, 55 por ciento por accidentes de tránsito y 23 por ciento por robos; 41 por ciento eran solamente fracturas del tercio superior y 59 por ciento acompañadas del tercio medio facial. Conclusiones: Las fracturas del tercio superior facial son importantes en la región de la cara. El diagnóstico clínico depende de la estructura afectada. Se debe actuar oportunamente para evitar secuelas y complicaciones. Los accidentes de tránsito y robos son causas que van en aumento. Se espera que este trabajo ayude a elaborar protocolos de atención en servicios de emergencia...

Introduction: Superior third facial fractures represent an important but rare pathology in the specialty of head, neck and maxillofacial surgery, and result from severe trauma. Objectives: To determine the presentation of superior third facial fractures by age, sex, causal agent and classification. Design: Observational descriptive study. Setting: Head, Neck and Maxillofacial Surgery Service, Dos de Mayo National Hospital, Lima, Peru. Participants: Patients with superior third facial fracture. Methods: Medical records data between June 1999 and May 2009 were captured. Main outcome measures: Age, sex, causing agent and classification. Results: Forty nine patients were included. Ninety per cent were male, about two thirds (67.5 per cent) were between 21 and 40 years old. More than half of the lesions (55 per cent) resulted from traffic accidents and 23 per cent from robberies; more than 40 per cent had superior third fractures only and 59 per cent were accompanied by midface fractures. Conclusions: Superior third facial fractures are important in the facial region. Clinical diagnosis depends on the affected structure. Treatment should be timely to prevent sequelae and complications. Traffic injuries and robberies are increasingly important causes. This study may contribute to developing treatment protocols in emergency services...

Reconstrucción mandibular con autoinjerto vascularizado de peron‚ en un caso de ameloblastoma multiqu¡stico / Mandibular reconstruction with vascularized fibular graft in a case of multicystic ameloblastoma

El ameloblastoma es una neoplasia benigna de origen epitelial; su lugar de aparici¢n, en la mayor¡a de casos, se encuantra entre las corticales ¢seas que conforman el maxilar, con mayor frecuencia en la mand¡bula, pocas veces se presentan de manera extra¢sea y suelen localizarse en la enc¡a. Puede aparecer en cualquier edad, pero con frecuencia es diagnosticada entre la cuarta y quinta d‚cada de vida. No existe predilecci¢n respecto alg£n sexo en particular, pero tiene una preferencia algo superior en varones. Existe una variedad de opciones quir£rgicas, de acuerdo al tipo histol¢gico y tama¤o de ameloblastoma, que est n bien documentadas en distintos reportes. En este reporte se presenta el caso de un paciente adulto al que se le realiz¢ una hemimandibulectom¡a, seguida de la reconstrucci¢n del defecto ¢seo con una placa preformada de titanio y un autoinjerto vascularizado de peron.

Ameloblastoma is a benign neoplasm of epithelial origin, in relation with its place of occurrence in most cases occur between the corticalplates that make up the jaw, being the place of most frequency the jaw, rarely presented extraosseous manner, and usually are locatedin the gingiva. In terms of age the tumor may appear at any age but is often diagnosed between the fourth and fifth decade of life. Thereis no predilection regarding with any particular sex but has a somewhat higher preference in males. A variety of surgical alternativesaccording to histological type and size of ameloblastoma which are well documented in various reports existed. In this report we presentthe case of an adult patient who underwent an hemimandibulectomy, followed by reconstruction of the bone defect with a preformedtitanium plate and a vascularized fibular autograft.

Fracturas del tercio medio facial de trazo unilateral / Midface fractures unilateral stroke

Las fracturas del tercio medio facial de trazo unilateral son las más frecuentes del macizo óseo-facial en general; dentro de estas, las del maxilar superior son las de mayor incidencia. Se producen como consecuencia de traumatismo severos. Este tipo de fractura se determina por edad, sexo y agente causal importante para su manejo. Se pueden presentar en forma combinada con otro tipo de fractura facial. El tercio medio del macizo óseo-facial está conformado por un complejo de huesos unidos unos a otros, dentro de los que tenemos principalmente a los maxilares superiores, huesos propios nasales, malares y temporales. Se ha elaborado una clasificación que incluye las estructuras óseas mencionadas y a la vez es comprensible y de fácil aplicación. Para la realización del estudio se revisaron historias clínicas de los pacientes portadores de fracturas unilaterales del tercio medio facial, desde junio 1999 hasta junio 2006. Se empleó una ficha de recolección de datos necesarios para la investigación. Se realizó un estudio tipo observacional descriptivo. Se revisaron 267 historias clínicas, el 84% corresponde al sexo masculino y el 67% estuvo entre 21-40 años de edad. El 45% fue causado por accidentes de tránsito y 23% agresiones por robo.

Manejo quirúrgico conservador de un caso de fibroma osificante juvenil / Conservative surgery management in a case of juvenile ossifying fibroma

El fibroma osificante juvenil es considerado una neoplasia fibro-benigna, de crecimiento rápido, más comúnmente diagnosticada en edades entre los cinco y los quince años. Nosotros reportamos un caso de fibroma osificante juvenil con retención de canino en maxilar superior, en una paciente mujer de 22 años de edad. El tratamiento consistió en extirpación del tumor, endodoncias y apicectomías en las piezas dentarias involucradas en la lesión.